Dr Katherine Irene Pettus, PhD, Advocacy Officer, International Association for Hospice and Palliative Care, explains the background to a new report published in Vienna on 3 February 2016 to improve access to controlled medicines.

The INCB (the ‘Board’) is an independent, quasi-judicial expert body, appointed by the UN Economic and Social Council. The Board is mandated by the Single Convention on Narcotic Drugs (1961,1972) to co-operate with governments to ensure that adequate supplies of controlled medicines are available to meet global public health needs. In order to assist governments to achieve a balance between supply and demand, the Board administers a system of annual estimates for controlled medicines and monitors licit activities through statistical returns.

The Board released its last supplement on controlled medicines in 2010, acknowledging that global consumption of narcotic drugs and psychotropic substances was far below the levels required for the most basic treatments and that more than 80% of the world had insufficient, or no access at all, to basic analgesia. The new supplement reports that although consumption of controlled medicines continues to increase in the world’s wealthier countries, key gaps and barriers persist in the lower- and middle-income countries.

The “fear of addiction” barrier, which led the pack in the 2010 supplement, dropped to second place behind the newly identified barrier of lack of professional education and awareness. Fear of addiction is closely related to lack of education though, since public health curricula that include sections on dependence disorder, prevention, and treatment, and teach distinctions between dependence, tolerance, and problematic use, displace fear with evidence.

Interestingly, the new supplement states: “two-thirds of countries consider their [opioid] situation satisfactory or entirely satisfactory (46 and 22 percent, respectively) while others indicated the need for some (22 percent) or significant improvement (7 percent).” Yet, “out of 96 valid responses to this specific question, 36 percent of countries indicated as a major impediment, a lack of training or awareness among members of the medical profession regarding the use of narcotic drugs. This was followed by fear of addiction (34 percent) and limited financial resources (32 percent).” Government officials with more education and awareness about the rational use of controlled medicines to treat pain, mental health conditions, and dependence syndrome might give different satisfaction scores and revise their opinions on the need to improve access.

Supplement calls for more training in the use of controlled medicines

The new supplement sends a clear message that governments must require scaled-up professional training in the use of controlled medicines where consumption is low or inadequate: more than 70% of the world. Although global, regional, and national associations such as IAHPC, EAPC, APCA, ALCP, ICPCN, and Pallium India, to name only a few, struggle with limited funding to provide educational workshops, bursaries, and fellowships for colleagues eager to learn, they need more robust support and collaboration from governments and UN organisations in order for the next INCB supplement to report that the training and awareness raising is taking place, and that the pandemic of untreated pain is abating. Civil society advocates are working to ensure that the upcoming UN General Assembly Special Session on the World Drug Problem will issue an authoritative political mandate requiring member states to remedy the lack of availability of controlled medicines through multi-sector collaborations that strengthen health and governance institutions, and enhance public health education.

The new INCB supplement is a great tool for advocacy, and can be used by countries, regions, and globally to analyse the situation and argue for policies to promote greater education.

We plan shortly to publish another post on opioid access from Willem Scholten and Jack E. Henningfield. You can also view previous posts from Katherine Pettus and others in the Opioid Access category of the EAPC Blog.

INCB takes a level of adequate opioid analgesic consumption which is 30 times lower than that considered adequate by WHO research papers. For me, this is the level of torture, not the level where our advocacy should go for. Moreover, the report is highly suggestive that industrialised countries consume too much (e. g. see red colour in the map), while there is evidence that even in these countries pain management is at a lousy level.